A paradigm shift is taking place in the world of medicine. Point-of-care ultrasonography is redefining the very essence of the physical examination and the way clinicians practice medicine. This portable, high-quality, digital imaging technology has been shown to significantly improve the quality of healthcare. It allows physicians to make more informed decisions and provide superior patient care. Coined the “stethoscope of the future,” point-of-care ultrasonography can be practiced at almost any patient care site from a resource-constrained rural setting to a modem urban emergency department. Point-of-care ultrasound refers to the use of portable ultrasonography at a patient's bedside for diagnostic (e.g., symptom or sign-based examination) and therapeutic (e.g., image-guidance) purposes.
Ultrasound applications have continued to expand in the past decade. The spectrum of users now includes virtually every type of medical practitioner, ranging from nurses and primary care providers to most every physician subspecialist. There are approximately 4,000,000 potential users (nurses and physicians) in the United States and an estimated 24,000,000 globally. The principal barrier to use of this life-saving technology is lack of ultrasound training. User adoption is limited by the psychomotor skills required to manipulate an ultrasound probe coupled with the ability to interpret the resulting ultrasound images. It is clear that medical education must catch up with the expanded use of ultrasonography if tomorrow's practitioners are to provide superior healthcare for their patients.
Point-of-care ultrasonography has the potential to save hundreds of millions of dollars on an annual basis across health systems. It has the capacity to revolutionize patient care and improve procedural efficacy, decrease complications, and limit pain and suffering. A primary barrier to future universal adoption of this operator-dependent “stethoscope of the future” is the lack of widespread, efficient, and affordable training solutions. The acquisition of ultrasound skills has traditionally been limited by high opportunity costs.
Developing competence on performing ultrasonography and applying the results to clinical care is understandably a complex process. It requires integrated cognitive (image interpretation) and psychomotor (optimal image window acquisition) skills. Once an optimal image window is acquired and correctly interpreted, the information needs to be correctly applied to patient care. The opportunity cost of training healthcare providers on ultrasonography is extremely high. Optimal training requires: (1) a qualified instructor; (2) trainees; (3) an ultrasound machine; and (4) a patient with a pathologic condition. All of these elements must come together in the same place and at the same time. Furthermore, trainees must be exposed to a sufficient number of new patients exhibiting distinct pathologic conditions over an extended period of time to attain adequate mastery. It may take months to years before a care provider is able to scan a sufficient number of patients with certain pathologic conditions (e.g., leaking abdominal aortic aneurysm) to develop competence, especially considering that these clinical encounters are unpredictable. The inability to train on sufficient numbers of pathologic cases (abnormals) is a recognized impediment to ultrasound competency.
Currently available training methods all have significant limitations. These include clinical bedside teaching, attending hands-on training courses, use of phantom models, and high-fidelity yet very expensive ultrasound simulator workstations. They may involve bulky training platforms that require multiple users to visit a simulation center (e.g., UltraSim®, CAE Healthcare) or require the presence of an actual ultrasound machine (e.g., Blue Phantomml™). These ultrasound-training solutions employ high-priced dedicated computer hardware and software that does not deploy over the Internet. Alternative training products provide a limited library of purely didactic training solutions that are not accompanied with any hands-on training experience (e.g., EMSONO).